Provider Demographics
NPI:1891052981
Name:MCLEAN, KRISTAN M (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTAN
Middle Name:M
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:KRISTAN
Other - Middle Name:M
Other - Last Name:REAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:408 HIGHLAND AVE
Mailing Address - Street 2:SUITE 7 BUILDING A
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2525
Mailing Address - Country:US
Mailing Address - Phone:203-872-2099
Mailing Address - Fax:
Practice Address - Street 1:408 HIGHLAND AVE
Practice Address - Street 2:SUITE 7 BUILDING A
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2525
Practice Address - Country:US
Practice Address - Phone:203-872-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT101Y00000XMedicaid